Lung cancer surgery: innovations and future perspectives

Nine decades ago in 1933, Evarts A. Graham performed the first successful pneumonectomy in a patient with primary pulmonary squamous cell carcinoma. The patient survived for another 30 years, which drew the curtain on the surgical treatment of lung cancer. Surgical resection continues to be the cornerstone of multidisciplinary treatment for patients with early-stage non-small cell lung cancer and a proportion of those with locally advanced disease. Moreover, recent years have seen developments in automatic control, biomechanics, robotics, image transmission, artificial intelligence, three-dimensional reconstruction and printing, biological pharmacy, and molecular biology. Therefore, there is now an increasing focus on how to integrate these technologies into lung cancer surgery to improve quality of life, resect the tumor accurately, expand the population that is suitable for surgical management, predict disease recurrence with better accuracy, and ultimately achieve long-term survival. This article systematically reviews the innovative achievements that may be detrimental to current clinical practice and in future clinical trials, and simultaneously provides a brief overview of the polyvagal perspective in this field.